Workplace Violence
The National Health Service
Since 1948, residents of the UK are provided with their healthcare services through the publicly-funded health care system known as the NHS. Health services included primary care, emergency care, in-patient care, long-term care, ophthalmology and dentistry. To date, the service remains free of charge with the exception of certain optical and dental prescriptions, for any resident of the UK regardless of financial status. The webpage of the NHS indicates that it employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff (About the NHS, 2009). Despite having this large number of employees, the NHS finds itself still underemployed. The NHS provides 60 million people and an average of 1.7 million patients seeking medical attention every 36 hours. In an industry where service is being provided, being understaffed leads to overworked employees leading to greater risk of workplace violence secondary to the high stress levels already associated with the nature of their work (About the NHS, 2009).
Definition of Workplace Violence
Violence in the workplace can be defined as any behaviour whenever and person is threatened, intimidated, abused, or assaulted at or relating to his or her employment. Acts of which include verbal or written threats, harassments that demean or humiliate the recipient, verbal abuse such as insults or cursing, threatening behaviour, and the physical acts including pushing and kicking. The act of violence does not need to be confined in the workplace itself but also in events outside the office or anywhere where co-workers, employer-employees have a chance to interact with each other. Threatening telephone calls are also considered as an act of workplace violence (Dealing, n.d.).
Factors that pose greater risk for workplace violence are lack of patience, disappointment, anxiety, regret, drinking, drugs or intrinsic aggression or lack of mental stability (Workplace Violence, 2009). Since there is an understaffing of general practitioners in the NHS, patients find themselves waiting in long cues. These patients soon become impatient, frustrated due to their feelings of discomfort and illness, and not knowing the cause of their illness, anxious due to their lack of choice in being in the hospital against their wishes. Hospital staff who work with patients who may have poor impulse or anger control, who are under the influence of alcohol, drugs, even prescription drugs, or are mentally unstable are at the greatest risk (Beech Lether, 2006, p. 30). At the end of the day, it is the nurses, receptionists or other health care providers who bare the brunt of patients frustrations.
However, it is not only from the patients where the staff of the NHS may get their stress from. It can come from the organisation and the work conditions, such as shifting schedules, long hours of work, or demoralisation of workers. Nurses are at particular risk because they have to deal both with multiple superiors such as doctors and their patients. According to the ILO Fact Sheet (2003), compared to other professions, the NHS reported higher levels of occupational stress with 28 of nurses suffering at least minor mental health problems as compared to 18 in the general public. Absences due to sickness are also reported to be higher (5) costing the NHS 700 million a year.
This is what makes workplace violence in the NHS different from the risk of violent assaults in other sectors. As in other sectors, workplace violence may take place between two disgruntled employees or between employer and employee in other words, only within the organisation. Whereas in the NHS or any health sector, health workers are exposed to pressures both from the organisation and the society of whom who have different behaviours. The definition of the workplace is also not confined within the walls of the hospital. The workplace also includes any place where health care is provided such as the ambulance, site of the accident, or the patients home (ILOICNWHOPSI Joint Programme, 2002).
Scope and Impact of Stress and Violence in the National Health Services
For health workers who are front liners of people in distress, stress and violence are such commonplace that they are being considered part of their daily jobs. However, when health workers feel strained with the work conditions and where there are staff shortages, low pay, schedule shifts, transportation to work and other conditions that make them vulnerable to stress and violence, the delivery of health care services is likely to deteriorate. The consequence of which is more irate patients. The health workers may then decide to leave the profession leading to more staff shortages. In 1996 for example, 30,000 nurses left the profession due to various reasons, increasing the strain on those who remained. This can result in the reduction of health services available to the general public and cause an overall increase in health care costs (ILO factsheet, 2003).
Background of Stress and Violence
The basis of most workplace violence can be attributed to stress. In a study conducted by behavioural neuroscientists from the Netherlands on rats, when electrically stimulating the part of the brain, the hypothalamus, which is associated with emotion, a sudden release of corticosterone, a hormone that is similar to the stress hormone in humans, corticosterol, occurs. The scientists surgically took off the rats adrenal glands which secreted corticosterone, to preclude the natural occurrence of the hormone. Then the rats were injected with corticosterone. Within minutes of the injection, the rats evoked an aggressive behaviour. With rapid succession of stimulating the brain and injecting the rats with corticoterone, the level of aggression increased. This showed that there is a cycle between brain stimulation (stress) and the adrenal glands (aggression), the stress-violence cycle or what the scientists call the vicious cycle. If extended in research to humans, this would explain why when people are exposed to different stressors from earlier in the day even in small amounts, would lash out at the most innocent things (as cited in Parker, 2004).
Strategies to Address Workplace Violence
In order to reduce the incidence of workplace violence in health care, the importance of training must be asserted. Appropriate training for prevention of workplace violence must be given to all members of the hospital staff whether or not they are permanent or temporary employees. Elliott, writing from a U.S. perspective, asserted, ball staff must be trained in basic violence behaviour prevention and they must know the correct emergency response procedures (1997, p. 40). The training must include (1) awareness and understanding, (2) rights and responsibilities, and (3) intervention.
At the beginning of the training, the staff must be able to understand the different terms used in describing acts of violence. One must recognise between physical and psychological violence. The former meant the use of physical force against another person or group, which results in physical, sexual or psychological harm. It includes beating, kicking, slapping, stabbing, shooting, pushing, biting, pinching, among others (WHO, 2002). While the latter meant the deliberate use of power, encompassing the threat of physical power. This is exerted against another individual, which may jeopardize another in various aspects. This encompasses verbal abuse, bullying, feelings of being harassed, and verbal threats (WHO, 2002).
Employees must be aware of any warning signals of violence such as aggressivehostile postures and attitudes, repeated manifestations of discontent, irritation or frustration, alterations in tone of voice, size of the pupils of the eyes, muscle tension, sweating, and the escalation of signals and the building up of tense situations, in order for necessary safety measures to be taken.
The government should provide the framework policies to reduce and eliminate workplace violence (ILOICNWHOPSI Joint Programme, 2002). Plans and policies should include human rights protection, occupational health and safety, economic stability, gender equality and so forth.
Employers and employees must recognise both their rights and responsibilities. Employers for their part should take responsibility for ensuring the overall health and safety of all employees by eliminating predictable risk of workplace violence. They ought to develop plans and policies to combat workplace violence and delegate managers at all levels to implement them. A conversation between managers and other staff representatives to improve on the policies will give views on both sides of the fence and create a more relaxed working environment. Adequate reporting systems should also be provided. Employees should take into themselves the responsibility of eliminating risks associated with workplace violence including following workplace policies, attend trainings, report any incidents, and seeking guidance and counselling if involved in situations that may lead to workplace violence (ILOICNWHOPSI Joint Programme, 2002).
Intervention
Reporting all incidents, mo matter how minor they are, is the first intervening step to avoid workplace violence. The second step is to follow-through on that incident report. Surveys done abroad such as Bulgaria, Thailand and South Africa, in more than 30 of the time people said that they pretended that nothing had happened. They kept the incident for themselves because they felt that reporting it was useless andor it may bring negative consequences such as more frequent bullying (Martino, 2002). The study further reviewed that of the incidents were reported, less than 50 were investigated and that most perpetrators were not sanctioned. This brings dissatisfaction on the part of the victim giving them the perception that reporting incidents are useless. A system must be created to encourage incidents to be reported. According to Martino (2002), there should be specific people or work groups that address workplace violence. Their primary responsibility should cover surveillance and tracking, documentation, research, compensating victims and supposed suspects, and their reprimand. Providing assistance (i.e. legal aid) for those affected by workplace violence may encourage increased reports of incidents (ILOICNWHOPSI Joint Programme, 2002). Counselling should also be provided for both the victim and the perpetrator.
Organisational Interventions
According to ILOICNWHOPSI Joint Programme (2002), organisational interventions must be given the highest priority in reducing risk of workplace violence. Practises can be adjusted based on specific situations such as the problem of staffing. The health service can raise the number of staff members or have more experienced staff at peak periods, during patient transfers, emergencies, admissions, meal times and even at night and for patients with a history of violent behaviour. Management styles can include having an open communication between managers and employees for a more participative approach. Although an organisation can adopt a systematic approach wherein there is a step-ladder as to how an incident is reported such as violence recognition then risk assessment then intervention then monitoring and evaluation, the organisation can still work on a participative approach wherein all levels work together in making and implementing anti-violence initiatives. Setting aside a day of the week or the month on a regular workday for such meetings may prove to be helpful. Work practises can also be improved such as tailoring client flow to schedules depending on resources and staff available to keep waiting times to a minimum and avoid overcrowding. (ILOICNWHOPSI Joint Programme, 2002).
Conclusion
Workplace violence in the health sector is increasingly recognised as a serious problem for both managers and staff. In order to reduce such incidences, training must be provided on all levels of the hospital. Employers or the management must create policies and protocols in order to protect the safety and health of the employees. Employees on their part must follow these policies and report immediately any incidents. Managers and employees working together is also advantageous.
Improving problems at the organisational level is cost effective in reducing workplace violence such as increasing staff members, studying their rotational duties as to provide more efficient care during peak times and emergencies, improving work conditions such as better ventilation and prevention of overcrowding. Little improvement in these areas can reduce levels of stress, preventing the feedback loop to aggressive behaviour and thus, reducing risks of workplace violence.
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